Failure to Report Resident-to-Resident Abuse Allegation
Penalty
Summary
The facility failed to report an allegation of resident-to-resident abuse to both the facility's Abuse Coordinator and the State Agency for two of three residents reviewed for abuse. According to the facility's Abuse, Neglect and Exploitation policy, all alleged violations must be reported to the Administrator, state agency, and other required agencies within specified timeframes. In this case, a verbal altercation, including threats of physical harm, occurred between two residents. The incident was documented in one resident's care plan after being discussed in a morning meeting, but no abuse report was made to the Abuse Coordinator or the State Agency. The Social Service Director confirmed she documented the incident in the care plan based on information from a morning meeting but was not present during the weekend when the incident occurred and could not identify the reporting nurse. The Administrator in Training, who also serves as the facility's Abuse Coordinator, confirmed she was not informed of the incident and that no abuse report was submitted to the state agency. The lack of communication and failure to follow reporting procedures resulted in the deficiency.